TY - JOUR A1 - Jun, Kyong-Hwa A1 - Gholami, Spedideh A1 - Song, Tae-Jin A1 - Au, Joyce A1 - Haddad, Dana A1 - Carson, Joshua A1 - Chen, Chun-Hao A1 - Mojica, Kelly A1 - Zanzonico, Pat A1 - Chen, Nanhai G. A1 - Zhang, Qian A1 - Szalay, Aladar A1 - Fong, Yuman T1 - A novel oncolytic viral therapy and imaging technique for gastric cancer using a genetically engineered vaccinia virus carrying the human sodium iodide symporter JF - Journal of Experimental & Clinical Cancer Research N2 - Background: Gastric cancers have poor overall survival despite recent advancements in early detection methods, endoscopic resection techniques, and chemotherapy treatments. Vaccinia viral therapy has had promising therapeutic potential for various cancers and has a great safety profile. We investigated the therapeutic efficacy of a novel genetically-engineered vaccinia virus carrying the human sodium iodide symporter (hNIS) gene, GLV-1 h153, on gastric cancers and its potential utility for imaging with Tc-99m pertechnetate scintigraphy and I-124 positron emission tomography (PET). Methods: GLV-1 h153 was tested against five human gastric cancer cell lines using cytotoxicity and standard viral plaque assays. In vivo, subcutaneous flank tumors were generated in nude mice with human gastric cancer cells, MKN-74. Tumors were subsequently injected with either GLV-1 h153 or PBS and followed for tumor growth. Tc-99m pertechnetate scintigraphy and I-124 microPET imaging were performed. Results: GFP expression, a surrogate for viral infectivity, confirmed viral infection by 24 hours. At a multiplicity of infection (MOI) of 1, GLV-1 h153 achieved > 90% cytotoxicity in MNK-74, OCUM-2MD3, and AGS over 9 days, and >70% cytotoxicity in MNK-45 and TMK-1. In vivo, GLV-1 h153 was effective in treating xenografts (p < 0.001) after 2 weeks of treatment. GLV-1 h153-infected tumors were readily imaged by Tc-99m pertechnetate scintigraphy and I-124 microPET imaging 2 days after treatment. Conclusions: GLV-1 h153 is an effective oncolytic virus expressing the hNIS protein that can efficiently regress gastric tumors and allow deep-tissue imaging. These data encourages its continued investigation in clinical settings. KW - oncolytic viral therapy KW - GLV-1 h153 KW - gastric cancer KW - human sodium iodide symporter (hNIS) KW - radioiodine therapy KW - gene therapy KW - expression KW - replication KW - stomach KW - tumors KW - surgery Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-117716 SN - 1756-9966 VL - 33 IS - 2 ER - TY - JOUR A1 - Jakubietz, Michael G. A1 - Meffert, Rainer H. A1 - Schmidt, Karsten A1 - Gruenert, Joerg G. A1 - Jakubietz, Rafael G. T1 - Acute A4 Pulley Reconstruction with a First Extensor Compartment Onlay Graft JF - Plastic and Reconstructive Surgery Global Open N2 - Background: The integrity of the flexor tendon pulley apparatus is crucial for unimpaired function of the digits. Although secondary reconstruction is an established procedure in multi-pulley injuries, acute reconstruction of isolated, closed pulley ruptures is a rare occurrence. There are 3 factors influencing the functional outcome of a reconstruction: gapping distance between tendon and bone (E-space), bulkiness of the reconstruction, and stability. As direct repair is rarely done, grafts are used to reinforce the pulley. An advantage of the first extensor retinaculum graft is the synovial coating providing the possibility to be used both as a direct graft with synovial coating or as an onlay graft after removal of the synovia when the native synovial layer is present. Methods: A graft from the first dorsal extensor compartment is used as an onlay graft to reinforce the sutured A4 pulley. This technique allows reconstruction of the original dimensions of the pulley system while stability is ensured by anchoring the onlay graft to the bony insertions of the pulley. Results: Anatomical reconstruction can be achieved with this method. The measured E-space remained 0 mm throughout the recovery, while the graft incorporated as a slim reinforcement of the pulley, displaying no bulkiness. Conclusions: The ideal reconstruction should provide synovial coating and sufficient strength with minimal bulk. Early reconstruction using an onlay graft offers these options. The native synovial lining is preserved and the graft is used to reinforce the pulley. KW - surgery KW - pulley rupture Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-158057 VL - 5 IS - 6 ER - TY - JOUR A1 - Kämmerer, Peer W. A1 - Tribius, Silke A1 - Cohrs, Lena A1 - Engler, Gabriel A1 - Ettl, Tobias A1 - Freier, Kolja A1 - Frerich, Bernhard A1 - Ghanaati, Shahram A1 - Gosau, Martin A1 - Haim, Dominik A1 - Hartmann, Stefan A1 - Heiland, Max A1 - Herbst, Manuel A1 - Hoefert, Sebastian A1 - Hoffmann, Jürgen A1 - Hölzle, Frank A1 - Howaldt, Hans-Peter A1 - Kreutzer, Kilian A1 - Leonhardt, Henry A1 - Lutz, Rainer A1 - Moergel, Maximilian A1 - Modabber, Ali A1 - Neff, Andreas A1 - Pietzka, Sebastian A1 - Rau, Andrea A1 - Reichert, Torsten E. A1 - Smeets, Ralf A1 - Sproll, Christoph A1 - Steller, Daniel A1 - Wiltfang, Jörg A1 - Wolff, Klaus-Dietrich A1 - Kronfeld, Kai A1 - Al-Nawas, Bilal T1 - Adjuvant radiotherapy in patients with squamous cell carcinoma of the oral cavity or oropharynx and solitary ipsilateral lymph node metastasis (pN1) — a prospective multicentric cohort study JF - Cancers N2 - (1) Background: Evaluation of impact of adjuvant radiation therapy (RT) in patients with oral squamous cell carcinoma of the oral cavity/oropharynx (OSCC) of up to 4 cm (pT1/pT2) and solitary ipsilateral lymph node metastasis (pN1). A non-irradiated group with clinical follow-up was chosen for control, and survival and quality of life (QL) were compared; (2) Methods: This prospective multicentric comprehensive cohort study included patients with resected OSCC (pT1/pT2, pN1, and cM0) who were allocated into adjuvant radiation therapy (RT) or observation. The primary endpoint was overall survival. Secondary endpoints were progression-free survival and QL after surgery; (3) Results: Out of 27 centers, 209 patients were enrolled with a median follow-up of 3.4 years. An amount of 137 patients were in the observation arm, and 72 received adjuvant irradiation. Overall survival did not differ between groups (hazard ratio (HR) 0.98 [0.55–1.73], p = 0.94). There were fewer neck metastases (HR 0.34 [0.15–0.77]; p = 0.01), as well as fewer local recurrences (HR 0.41 [0.19–0.89]; p = 0.02) under adjuvant RT. For QL, irradiated patients showed higher values for the symptom scale pain after 0.5, two, and three years (all p < 0.05). After six months and three years, irradiated patients reported higher symptom burdens (impaired swallowing, speech, as well as teeth-related problems (all p < 0.05)). Patients in the RT group had significantly more problems with mouth opening after six months, one, and two years (p < 0.05); (4) Conclusions: Adjuvant RT in patients with early SCC of the oral cavity and oropharynx does not seem to influence overall survival, but it positively affects progression-free survival. However, irradiated patients report a significantly decreased QL up to three years after therapy compared to the observation group. KW - oral squamous cell carcinoma KW - oropharyngeal carcinoma KW - surgery KW - resection KW - radiotherapy KW - survival KW - progression-free survival KW - quality of life KW - prospective KW - multicentric KW - lymph node KW - pN1 Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-311024 SN - 2072-6694 VL - 15 IS - 6 ER - TY - JOUR A1 - Kunath, Frank A1 - Krause, Steffen F. A1 - Wullich, Bernd A1 - Goebell, Peter J. A1 - Engehausen, Dirk G. A1 - Burger, Maximilian A1 - Meerpohl, Joerg J. A1 - Keck, Bastian T1 - Bladder cancer - the neglected tumor: a descriptive analysis of publications referenced in MEDLINE and data from the register clinicaltrials.gov JF - BMC Urology N2 - Background: Uro-oncological neoplasms have both a high incidence and mortality rate and are therefore a major public health problem. The aim of this study was to evaluate research activity in uro-oncology over the last decade. Methods: We searched MEDLINE and ClinicalTrials.gov systematically for studies on prostatic, urinary bladder, kidney, and testicular neoplasms. The increase in newly published reports per year was analyzed using linear regression. The results are presented with 95% confidence intervals, and a p value <0.05 was considered statistically significant. Results: The number of new publications per year increased significantly for prostatic, kidney and urinary bladder neoplasms (all <0.0001). We identified 1,885 randomized controlled trials (RCTs); also for RCTs, the number of newly published reports increased significantly for prostatic (p = 0.001) and kidney cancer (p = 0.005), but not for bladder (p = 0.09) or testicular (p = 0.44) neoplasms. We identified 3,114 registered uro-oncological studies in ClinicalTrials.gov. However, 85% of these studies are focusing on prostatic (45%) and kidney neoplasms (40%), whereas only 11% were registered for bladder cancers. Conclusions: While the number of publications on uro-oncologic research rises yearly for prostatic and kidney neoplasms, urothelial carcinomas of the bladder seem to be neglected despite their important clinical role. Clinical research on neoplasms of the urothelial bladder must be explicitly addressed and supported. KW - update KW - kidney neoplasms KW - prostatic neoplasms KW - randomized controlled trial KW - testicular neoplasms KW - surgery KW - journals KW - EAU guidelines KW - radical cystectomy KW - urinary bladder neoplasms KW - controlled clinical-trials Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-122133 VL - 13 IS - 56 ER - TY - THES A1 - Kegel, Christian T1 - Der Verschluss nach alloplastischer infragenualer Gefäßrekonstruktion - Ursachen und Konsequenzen - Eine retrospektive Analyse 1993 - 2001 T1 - The occlusion after infragenual vascular reconstruction - the causes and consequences - a retrospective analysis 1993 - 2001 N2 - Einleitung: In der Behandlung der peripheren arteriellen Verschlusskrankheit (pAVK) hat die Implantation von Kunststoffprothesen einen festen Stellenwert. Allerdings weisen diese, eine höhere Thrombogenität, Infekt- und damit auch Verschlussrate als die Eigenvene auf. Im Falle eines Bypassverschlusses ist die Extremität häufig gefährdet und es ergibt sich ein unmittelbarer Handlungsbedarf. Ziel der hier dargestellten Untersuchung war es, über einen bestimmten Zeitraum alle Fälle mit Bypassverschluss zu erfassen, um prognostische Kriterien und ein optimiertes Management dieser Patienten herauszuarbeiten. Material und Methoden: Anhand der MS-Access-Gefäßdatenbank der Abteilung für vaskuläre und endovaskuläre Chirurgie der Universitätsklinik Würzburg wurden alle Patienten, die im Zeitraum vom 01.01.1993 bis zum 31.12.2001 wegen eines Bypass-Verschlusses nach kniegelenks-überschreitender Rekonstruktion vorstellig wurden, erfasst und anhand der Aktenlage analysiert. Dabei wurden folgende Daten in die Untersuchung miteinbezogen: demographische Aspekte, kardiovaskuläre Risikofaktoren, Voroperationen, Medikation, Symptomatik und Indikation zur Erstoperation sowie zum Verschlusszeitpunkt, Umstände der Operation/Behandlung (Notfall, Operateur, Dauer, angewandtes Verfahren) und Verlaufsdaten (Komplikationen, Letalität, Offenheits- und Amputationsrate). Diese Daten wurden zunächst in eine MS-Excel-Tabelle eingelesen und dann mit Hilfe der SPSS-Software ausgewertet. Hierzu wurde verwendet: Chi-Quadrat-Test (Fisher und Yates bzw. Mehta und Patel), U-Test nach Mann und Whitney (Rangsummentest), Rangvarianzanalyse nach Kruskal und Wallis, Rangkorrelation nach Kendall, Überlebensstatistik nach Kaplan und Meier sowie die daraus resultierende multivariate Überlebensstatistik nach dem „Proportional Hazards“-Modell von Cox verwendet. Ergebnisse: Im genannten Zeitraum wurden 202 Patienten an einem solchen Bypassverschluss behandelt. Aus statistischen Gründen wurde in den Fällen, in denen im Verlauf beide Beine betroffen waren, das zweite ausgeschlossen. Bei 78% (n=157) dieser Patienten lag bei Erstimplantation eine chronisch-kritische Ischämie vor (21% AVK Stadium III, 51% Stadium VI), was auch mit dem Vorliegen kardiovaskulärer Risikofaktoren und Herzinsuffizienz korrelierte. Insgesamt waren bei 76 Patienten ein- bzw. durchflussverbessernde Maßnahmen der Arteria femoralis superficialis vor der Erstimplantation durchgeführt worden. Bei 75% (n = 154) der Bypässe waren die distalen Anastomosen im Bereich der A. poplitea III, A. tibialis anterior und des Truncus tibiofibularis erfolgt, wobei auch der Stenosierungsgrad der distalen Anschlussgefäße mit dem AVK-Stadium korrelierte. Es zeigte sich, dass mehr als 79% (n = 161) der Bypässe innerhalb eines Jahres wieder verschlossen waren, 27,7 % sofort (0-3 Tage), 52,0% im Sinne eines Früh- (4-365 Tage) und 20,3% im Sinne eines Spätverschlusses (> 1 Jahr). 30,2% (n = 61) der Patienten mussten beim ersten Verschluss bereits major-amputiert werden, bei allen anderen wurden überwiegend operative Revaskularisierungsmaßnahmen durchgeführt, davon erhielten 34 einen neuen Bypass. Dies wurde um so häufiger ausgeführt, je später der Verschluss auftrat. Die Offenheitsrate lag nach 1 Jahr bei 18,9% und nach 3 Jahren bei 13,1%, die Beinerhaltungsrate bei 58,4% bzw. 55,9%. Die multivariaten Analyse zeigte, dass eine Antikoagulation mit Marcumar, die Verwendung von Polyester (Dacron®) und die Erfahrung des Operateurs einen positiven Einfluss hatten. Dagegen verschlechterte sich die Prognose hinsichtlich Letalität, Offenheit und Beinerhalt bei Vorliegen einer Herz- und/oder Niereninsuffizienz signifikant. Aus den erhobenen Daten konnte ein Prognoseindex ermittelt werden: In Verbindung mit der Ausprägung der Begleiterkrankungen und des Allgemeinzustandes des Patienten kann abgeschätzt werden, ob eine weitere Bein-erhaltende Operation sinnvoll ist oder eine großzügige Indikation zur Amputation gestellt werden sollte. Diskussion: Der Verschluss eines Kunststoffbypasses mit distaler Anastomose unterhalb des Kniegelenks geht mit einer sehr ungünstigen Prognose einher. Anhand des hier vorgestellten Prognoseindex soll es dem Behandelnden erleichtert werden, eine Entscheidung zu treffen, inwiefern weiterführende Maßnahmen indiziert sind, oder ob der Patient eher von einer Beinamputation profitiert. Eine Marcumarisierung nach erfolgreicher Behandlung eines solchen Verschlusses sollte generell empfohlen werden. Weiterhin ist zu diskutieren, ob nicht eine Optimierung der Ergebnisse (in geeigneten Fällen) mit der Durchführung einer intra-arteriellen Lyse zur Demaskierung der zugrunde liegenden Ursache und anschließender gezielter Beseitigung dieser Läsion zu erreichen wäre. Um die Resultate generell zu verbessern, wäre sicher auch eine regelmäßige Ultraschallkontrolle der Prothesen sinnvoll, um einen drohenden Verschluss („failing graft“) durch eine rechtzeitige Intervention zu verhindern. N2 - Introduction: The treatment of critical limb ischemia with alloplastic bypasses is common in vascular surgery if an autologous vein is not available. But they have compared with a vein graft a higher rate of thrombogenesis, infects and because of this of occlusion. In case of bypass occlusion there must be an immediate treatment because there is a high risk for limb-loss. The aim of this study was to register all cases of alloplastic bypass occlusion in a certain period to find out prognostic parameters and an optimal treatment of these patients. Methods: By means of the Microsoft access database of the the Department of Vascular and Endovascular Surgery of the University clinic in Wuerzburg, Germany, all the patients who had been treated because of an occlusion of an infragenual bypass in the period from the 1st of January in 1993 until the 31st of December in 2001, have been registered and by means of their files analyzed according to different factors: Demographic aspects, cardiovascular risks, preoperations, medical treatment, symptoms, indication and the kind of the first implantation and the treatment after occlusion, complications, letality, rates of openness and amputation. The data has been registered in a table of Microsoft excel and analyzed by a SPSS software. The following tests were used: Chi Quadrat test (Fisher and Yates, Metha and Pathel), the U-test (Rank-sum test of Mann and Whitney), the Kruskal-Wallis analysis of variance), the Kendal Rank korrelation, the Kaplan-Meier survival analysis and the multivariates survival analysis (Cox-Proportional-Hazards model) were used. Results: In that period 202 patients had such a bypass occlusion. Because of the statistics patients with two treated legs the second was not registered. In 78 % (n=157) the patients had a critical chronical ischemia (21% AVK III and 51% VI) by the time of the first bypass-implantation. This corellates with cardivascular risk factors and heart insufficiency. In all 76 patients had been surgically treated before bypass implantation for improving the flow of the arteria femoralis superficialis, significantly more smokers but they were considerably younger. In 75% (n=154) of the bypasses the distal anastomosis were localized at the popliteal artery III, the anterior tibial artery and the truncus tibiofibularis. The grade of stenosis of the distal connecting vessels is correlating with the status of the arterial occlusive disease. More than 75% (n=161) occluded within the first year, 27,7% at once (0-3 days), 52,0% in a sense of an early occlusion (4-365 days) and 20,3% in a sense of a late occlusion (more than 1 year). 30,2% of the patients (n=61) had a major amputation at the first occlusion, the others got surgical treatment for revascularization. 34 of these patients got a new bypass, this was as more often as later the first bypasses occluded. The rate of openness was after 1 year at 18,9% and after 3 years at 13,1%, the amputation rate was 41,6% respectively 44,1%. The multivariate survival analysis showed that an anticoagulation with cumarin, the use of polyester (Dacronâ) and the experience of the surgeon had positive influence on the prognosis. But the prognosis for letality, openness and amputation is bad if patients suffer from heart- and/or kidney insufficiency. Because of the registered data a prognosis index could be determined: It can be said that it depends on the general health and the side diseases of a patient if it is better to try a revasculary surgical treatment or to indicate an amputation on a large scale. Discussion: The occlusion of an alloplastic bypass with a distal anastomosis below the knee has a worse prognosis. The determined prognosis index can relieve the vascular surgeon to make a decision whether it is better for the patient to try a revascular treatment or to amputate. An anticoagulation with cumarin should be generally recommended. Further it should be discussed whether the results (in fitting cases) with intra arterial lysis with demasking the cause and following exactly removing of this lesion. To improve the results in general continuous checks with ultrasound should be made to prevent a “failing graft” by an early intervention. KW - femoro-crural KW - infragenual KW - Gefäßchirurgie KW - Bypassverschluss KW - Kunststoffbypass KW - vascular KW - surgery KW - bypass KW - infragenual KW - occlusion Y1 - 2006 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-21228 ER - TY - JOUR A1 - Diers, Johannes A1 - Baum, Philip A1 - Lehmann, Kai A1 - Uttinger, Konstatin A1 - Baumann, Nikolas A1 - Pietryga, Sebastian A1 - Hankir, Mohammed A1 - Matthes, Niels A1 - Lock, Johann F. A1 - Germer, Christoph-Thomas A1 - Wiegering, Armin T1 - Disproportionately high failure to rescue rates after resection for colorectal cancer in the geriatric patient population - A nationwide study JF - Cancer Medicine N2 - Background Colorectal cancer incidence increases with patient age. The aim of this study was to assess, at the nationwide level, in-hospital mortality, and failure to rescue in geriatric patients (≥ 80 years old) with colorectal cancer arising from postoperative complications. Methods All patients receiving surgery for colorectal cancer in Germany between 2012 and 2018 were identified in a nationwide database. Association between age and in-hospital mortality following surgery and failure to rescue, defined as death after complication, were determined in univariate and multivariate analyses. Results Three lakh twenty-eight thousands two hundred and ninety patients with colorectal cancer were included of whom 77,287 were 80 years or older. With increasing age, a significant relative increase in right hemicolectomy was observed. In general, these patients had more comorbid conditions and higher frailty. In-hospital mortality following colorectal cancer surgery was 4.9% but geriatric patients displayed a significantly higher postoperative in-hospital mortality of 10.6%. The overall postoperative complication rate as well as failure to rescue increased with age. In contrast, surgical site infection (SSI) and anastomotic leakage (AL) did not increase in geriatric patients, whereas the associated mortality increased disproportionately (13.3% for SSI and 29.9% mortality for patients with AI, both p < 0.001). Logistic regression analysis adjusting for confounders showed that geriatric patients had almost five-times higher odds for death after surgery than the baseline age group below 60 (OR 4.86; 95%CI [4.45–5.53], p < 0.001). Conclusion Geriatric patients have higher mortality after colorectal cancer surgery. This may be partly due to higher frailty and disproportionately higher rates of failure to rescue arising from postoperative complications. KW - colorectal cancer KW - geriatric KW - octogenerians KW - surgery Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-312858 VL - 11 IS - 22 ER - TY - THES A1 - Hager, Benjamin Dietrich T1 - Einfluss eines antibiotikagetränkten Schwammes auf sternale Wundkomplikationen - eine prospektiv randomisierte Doppelblindstudie T1 - Effect of a Gentamicin-Collagen Sponge on Sternal Wound Complications - a prospective, randomized, double-blind trial N2 - Die prophylaktische retrosternale Einlage eines Gentamicin-Kollagen Schwammes wurde in letzter Zeit in mehreren Studien untersucht und ist wird kontrovers diskutiert. Die vorliegende Studie ist die erste prospektiv randomisierte, Einzelzentrums-Doppelblind-Studie zur Untersuchung der Effektivität, im Hinblick auf die Reduktion sternaler Wundkomplikationen nach herzchirurgischen Eingriffen, eines retrosternal eingelegten Gentamicin-Kollagen-Schwammes. N2 - Prophylactic retrosternal placement of a Gentamicin-collagen sponge has been the subject of several recent clinical studies and is a matter of controversy. The present study is the first controlled, prospective, randomized, double-blind, single-center study to investigate the efficacy of a retrosternal Gentamicin-collagen sponge in reducing sternal wound complications after heart surgery. KW - Wundinfektion KW - Brustbein KW - Gentamicin KW - Kollagen KW - Kontrollierte klinische Studie KW - Placebo KW - Schwamm KW - Herzchirurgie KW - gentamicin KW - collagen KW - sternum KW - infection KW - surgery Y1 - 2011 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-74955 ER - TY - JOUR A1 - Jakubietz, Rafael G. A1 - Schmidt, Karsten A1 - Bernuth, Silvia A1 - Meffert, Rainer H. A1 - Jakubietz, Michael G. T1 - Evaluation of the intraoperative blood flow of pedicled perforator flaps using indocyanine green-fluorescence angiography JF - Plastic and Reconstructive Surgery – Global Open N2 - Background: Although indocyanine-green fluorescence angiography (ICG-FA) has been established as a useful tool to assess perfusion in free tissue transfer, only few studies have applied this modality to pedicled perforator flaps. As both volume and reach of pedicled perforator flaps are limited and tip necrosis often equals complete flap failure, ICG-FA may help to detect hypoperfusion in pedicled flaps. Methods: In 5 patients, soft tissue reconstruction was achieved with pedicled perforator flaps. ICG-FA was utilized intraoperatively to visualize flap perfusion. Results: Three pedicled anterolateral thigh flap flaps and 2 propeller flaps were transferred. ICG-FA detected hypoperfusion in 2 flaps. No flap loss occurred; in 2 cases, prolonged wound healing was encountered. Conclusions: ICG-FA confirmed clinical findings and reliably detected tissue areas with hypoperfusion. A clear cut-off point between nonvital tissue and such that stabilized in the following clinical course could not be found. ICG-FA is a promising technology which could also be used in pedicled perforator flaps. KW - surgery Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-202625 VL - 7 IS - 9 ER - TY - JOUR A1 - Moris, Lisa A1 - Van den Broeck, Thomas A1 - Tosco, Lorenzo A1 - Van Baelen, Anthony A1 - Gontero, Paolo A1 - Karnes, Robert Jeffrey A1 - Everaerts, Wouter A1 - Albersen, Maarten A1 - Bastian, Patrick J. A1 - Chlosta, Piotr A1 - Claessens, Frank A1 - Chun, Felix K. A1 - Graefen, Markus A1 - Gratzke, Christian A1 - Kneitz, Burkhard A1 - Marchioro, Giansilvio A1 - Salas, Rafael Sanchez A1 - Tombal, Bertrand A1 - Van Der Poel, Henk A1 - Walz, Jochen Christoph A1 - De Meerleer, Gert A1 - Bossi, Alberto A1 - Haustermans, Karin A1 - Montorsi, Francesco A1 - Van Poppel, Hendrik A1 - Spahn, Martin A1 - Briganti, Alberto A1 - Joniau, Steven T1 - Impact of lymph node burden on survival of high-risk prostate cancer patients following radical prostatectomy and pelvic lymph node dissection JF - Frontiers in Surgery N2 - Aim To determine the impact of the extent of lymph node invasion (LNI) on long-term oncological outcomes after radical prostatectomy (RP). Material and methods In this retrospective study, we examined the data of 1,249 high-risk, non-metastatic PCa patients treated with RP and pelvic lymph node dissection (PLND) between 1989 and 2011 at eight different tertiary institutions. We fitted univariate and multivariate Cox models to assess independent predictors of cancer-specific survival (CSS) and overall survival (OS). The number of positive lymph node (LN) was dichotomized according to the most informative cutoff predicting CSS. Kaplan–Meier curves assessed CSS and OS rates. Only patients with at least 10 LNs removed at PLND were included. This cutoff was chosen as a surrogate for a well performed PNLD. Results Mean age was 65 years (median: 66, IQR 60–70). Positive surgical margins were present in 53.7% (n = 671). Final Gleason score (GS) was 2–6 in 12.7% (n = 158), 7 in 52% (n = 649), and 8–10 in 35.4% (n = 442). The median number of LNs removed during PLND was 15 (IQR 12–17). Of all patients, 1,128 (90.3%) had 0–3 positive LNs, while 126 (9.7%) had ≥4 positive LNs. Patients with 0–3 positive LNs had significantly better CSS outcome at 10-year follow-up compared to patients with ≥4 positive LNs (87 vs. 50%; p < 0.0001). Similar results were obtained for OS, with a 72 vs. 37% (p < 0.0001) survival at 10 years for patients with 0–3 vs. ≥4 positive LNs, respectively. At multivariate analysis, final GS of 8–10, salvage ADT therapy, and ≥4 (vs. <4) positive LNs were predictors of worse CSS and OS. Pathological stage pT4 was an additional predictor of worse CSS. Conclusion Four or more positive LNs, pathological stage pT4, and final GS of 8–10 represent independent predictors for worse CSS in patients with high-risk PCa. Primary tumor biology remains a strong driver of tumor progression and patients having ≥4 positive LNs could be considered an enriched patient group in which novel treatment strategies should be studied. KW - high-risk prostate cancer KW - lymph node dissection KW - positive lymph node KW - prognosis KW - surgery Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-195721 SN - 2296-875X VL - 3 ER - TY - JOUR A1 - Wimmer, Matthias D. A1 - Randau, Thomas M. A1 - Deml, Moritz C. A1 - Ascherl, Rudolf A1 - Forst, Raimund A1 - Gravius, Nadine A1 - Wirtz, Dieter A1 - Gravius, Sascha T1 - Impaction grafting in the femur in cementless modular revision total hip arthroplasty: a descriptive outcome analysis of 243 cases with the MRP-TITAN revision implant JF - BMC Musculoskeletal Disorders N2 - Background: We present a descriptive and retrospective analysis of revision total hip arthroplasties (THA) using the MRP-TITAN stem (Peter Brehm, Weisendorf, GER) with distal diaphyseal fixation and metaphyseal defect augmentation. Our hypothesis was that the metaphyseal defect augmentation (Impaction Bone Grafting) improves the stem survival. Methods: We retrospectively analyzed the aggregated and anonymized data of 243 femoral stem revisions. 68 patients with 70 implants (28.8%) received an allograft augmentation for metaphyseal defects; 165 patients with 173 implants (71.2%) did not, and served as controls. The mean follow-up was 4.4 +/- 1.8 years (range, 2.1-9.6 years). There were no significant differences (p > 0.05) between the study and control group regarding age, body mass index (BMI), femoral defects (types I-III as described by Paprosky), and preoperative Harris Hip Score (HHS). Postoperative clinical function was evaluated using the HHS. Postoperative radiologic examination evaluated implant stability, axial implant migration, signs of implant loosening, periprosthetic radiolucencies, as well as bone regeneration and resorption. Results: There were comparable rates of intraoperative and postoperative complications in the study and control groups (p > 0.05). Clinical function, expressed as the increase in the postoperative HHS over the preoperative score, showed significantly greater improvement in the group with Impaction Bone Grafting (35.6 +/- 14.3 vs. 30.8 +/- 15.8; p <= 0.05). The study group showed better outcome especially for larger defects (types II C and III as described by Paprosky) and stem diameters >= 17 mm. The two groups did not show significant differences in the rate of aseptic loosening (1.4% vs. 2.9%) and the rate of revisions (8.6% vs. 11%). The Kaplan-Meier survival for the MRP-TITAN stem in both groups together was 93.8% after 8.8 years. [Study group 95.7% after 8.54 years; control group 93.1% after 8.7 years]. Radiologic evaluation showed no significant change in axial implant migration (4.3% vs. 9.3%; p = 0.19) but a significant reduction in proximal stress shielding (5.7% vs. 17.9%; p < 0.05) in the study group. Periprosthetic radiolucencies were detected in 5.7% of the study group and in 9.8% of the control group (p = 0.30). Radiolucencies in the proximal zones 1 and 7 according to Gruen occurred significantly more often in the control group without allograft augmentation (p = 0.05). Conclusion: We present the largest analysis of the impaction grafting technique in combination with cementless distal diaphyseal stem fixation published so far. Our data provides initial evidence of improved bone regeneration after graft augmentation of metaphyseal bone defects. The data suggests that proximal metaphyseal graft augmentation is beneficial for large metaphyseal bone defects (Paprosky types IIC and III) and stem diameters of 17 mm and above. Due to the limitations of a retrospective and descriptive study the level of evidence remains low and prospective trials should be conducted. KW - prosthesis KW - replacement KW - collarless KW - surgery KW - allografts KW - porous-coated stems KW - femoral revision KW - roentgenographic assessment KW - tapered stem KW - follow-up KW - modular KW - revision KW - hip KW - arthroplasty KW - impaction bone grafting Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-122061 SN - 1471-2474 VL - 14 IS - 19 ER - TY - THES A1 - Majer, Melanie T1 - Intra- und postoperative Komplikationen bei der operativen Entfernung von Weisheitszähnen : eine retrospektive Analyse des Krankengutes der Klinik und Poliklinik für Mund-, Kiefer-, Gesichtschirurgie der Universität Würzburg über die Jahre 1996 bis 1999 T1 - Complications with third molar surgery N2 - Diese Arbeit stellt eine retrospektive Studie dar und zeigt die Vorkommnisse von intra- und postoperativen Komplikationen bei der operativen Weisheitszahnentfernung. Die Studie beinhaltet die Analyse eines Patientengutes von 989 Patienten, bei denen, über den Zeitraum von 1996 bis 1999 insgesamt 1.750 Sapientes in der Poliklinik für Mund-, Kiefer-, Gesichtschirurgie der Universität Würzburg operativ entfernt wurden. Die intraoperativen Komplikationen zeigen eine Häufigkeit bei der Kronen- bzw. Wurzelfraktur sowie Mund-Antrum-Verbindung. Einzelne Komplikationen wie Nachbarzahnverletzung, Weichteilverletzung, unkontrollierte intraoperative Blutung, Prolaps des Bichat'schen Fettpfropfes, Alveolarkammverletzung, Tuberabriss oder Nervverletzungen wurden nur selten beobachtet. Bei den postoperativen Komplikationen kam das postoperative Ödem am häufigsten vor, gefolgt von Schmerzen, Infektion und Hämatom. Die Ergebnisse zeigen, dass die operative Weisheitszahnentfernung, die heutzutage als Routineeingriff in der Zahnmedizin zählt, trotz modernisierter Instrumente, standardisierter Techniken und medikamentöser Möglichkeiten, immer noch intra- und postoperative Komplikationen mit sich bringt. Ein Großteil der Komplikationen, der sich aus der Anatomie der Zähne und umgebenden Strukturen ergibt, könnte durch die möglichst frühzeitige Entfernung der Sapientes vermieden werden. Dies sollte bereits im Alter von 16 bis 22 Jahren geschehen, wenn das Wurzelwachstum der Weisheitszähne noch nicht abgeschlossen, aber die Tendenz einer Verlagerung oder Retention bereits im Röntgenbild sichtbar ist. Auf diese Weise sind Komplikationen zwar nicht vollständig zu vermeiden, aber das Risiko des operativen Eingriffs und dessen Folgeerscheinung ist jedoch geringer. N2 - Third molar extraction is one of the most often done surgery by dentists. There are many reasons, that make wisdom tooth removal necessary today - for example: dentitio difficilis, pain, inflammation, cysts, cancer, impacted or retained third molars etc.. This essay is based on an anlaysis of 1.240 operations at the Julius-Maximilian-University of Wurzburg in the years 1996-1999. In this time 1.750 wisdom teeth were operated. The results show a high score in wisdom tooth's ruptur of crown or root, sinus opening and affected nerves during operation. After surgery the complications appeared as extraordinary pain, swelling and inflammation. According to this analysis third molars should be extracted as early as possible - for example when it is obvious that an ordinary eruption is not possible or at first complaints. KW - Weisheitszahnentfernung KW - Komplikationen KW - Würzburg KW - Third molar KW - surgery KW - complications Y1 - 2006 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-25560 ER - TY - THES A1 - Majer, Melanie T1 - Intra- und postoperative Komplikationen bei der operativen Entfernung von Weisheitszähnen : eine retrospektive Analyse des Krankengutes der Klinik und Poliklinik für Mund-, Kiefer-, Gesichtschirurgie der Universität Würzburg über die Jahre 1996 bis 1999 T1 - Complications with third molar surgery N2 - Diese Arbeit stellt eine retrospektive Studie dar und zeigt die Vorkommnisse von intra- und postoperativen Komplikationen bei der operativen Weisheitszahnentfernung. Die Studie beinhaltet die Analyse eines Patientengutes von 989 Patienten, bei denen, über den Zeitraum von 1996 bis 1999 insgesamt 1.750 Sapientes in der Poliklinik für Mund-, Kiefer-, Gesichtschirurgie der Universität Würzburg operativ entfernt wurden. Die intraoperativen Komplikationen zeigen eine Häufigkeit bei der Kronen- bzw. Wurzelfraktur sowie Mund-Antrum-Verbindung. Einzelne Komplikationen wie Nachbarzahnverletzung, Weichteilverletzung, unkontrollierte intraoperative Blutung, Prolaps des Bichat'schen Fettpfropfes, Alveolarkammverletzung, Tuberabriss oder Nervverletzungen wurden nur selten beobachtet. Bei den postoperativen Komplikationen kam das postoperative Ödem am häufigsten vor, gefolgt von Schmerzen, Infektion und Hämatom. Die Ergebnisse zeigen, dass die operative Weisheitszahnentfernung, die heutzutage als Routineeingriff in der Zahnmedizin zählt, trotz modernisierter Instrumente, standardisierter Techniken und medikamentöser Möglichkeiten, immer noch intra- und postoperative Komplikationen mit sich bringt. Ein Großteil der Komplikationen, der sich aus der Anatomie der Zähne und umgebenden Strukturen ergibt, könnte durch die möglichst frühzeitige Entfernung der Sapientes vermieden werden. Dies sollte bereits im Alter von 16 bis 22 Jahren geschehen, wenn das Wurzelwachstum der Weisheitszähne noch nicht abgeschlossen, aber die Tendenz einer Verlagerung oder Retention bereits im Röntgenbild sichtbar ist. Auf diese Weise sind Komplikationen zwar nicht vollständig zu vermeiden, aber das Risiko des operativen Eingriffs und dessen Folgeerscheinung ist jedoch geringer. N2 - Third molar extraction is one of the most often done surgery by dentists. There are many reasons, that make wisdom tooth removal necessary today - for example: dentitio difficilis, pain, inflammation, cysts, cancer, impacted or retained third molars etc.. This essay is based on an anlaysis of 1.240 operations at the Julius-Maximilian-University of Wurzburg in the years 1996-1999. In this time 1.750 wisdom teeth were operated. The results show a high score in wisdom tooth's ruptur of crown or root, sinus opening and affected nerves during operation. After surgery the complications appeared as extraordinary pain, swelling and inflammation. According to this analysis third molars should be extracted as early as possible - for example when it is obvious that an ordinary eruption is not possible or at first complaints. KW - Weisheitszahnentfernung KW - Komplikationen KW - Würzburg KW - Third molar KW - surgery KW - complications Y1 - 2006 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-20664 ER - TY - THES A1 - Gerlach, Annette Friederike T1 - Langzeitergebnisse des primär laparoskopischen Magenbypass bei morbid adipösen Patienten : Eine retrospektive Studie an 60 Patienten T1 - Laparoscopic Roux-en-YGastric Bypass Surgeryin the Obesity Center Wuerzburg – Patient Selection and Results N2 - Die bariatrische Chirurgie stellt aktuell die effektivste Therapieoption der morbiden Adipositas dar. Eine chirurgische Intervention ermöglicht einen langfristigen Gewichtsverlust und eine signifikante Reduktion der adipositasassoziierten Begleiterkrankungen. In der Therapie der morbiden Adipositas gilt der laparoskopische Roux-Y-Magenbypass als das effektivste bariatrisch chirurgische Therapieverfahren. In der vorliegenden Studie wurden die Kurz- und Langzeitergebnisse der ersten 60 am Universitätsklinikum Würzburg operierten Patienten retrospektiv erfasst und analysiert. Es wurden intra- und postoperative Komplikationen, Gewichtsverlauf, Entwicklung der Komorbiditäten und postoperativ relevante Laborparameter mit Schwerpunkt auf Mangelerscheinungen untersucht und ausgewertet. Eine, von einem erfahrenen interdisziplinären Team sorgfältige präoperativ durchgeführte Patientenselektion ist die Grundvoraussetzung für eine erfolgreiche bariatrisch-chirurgische Therapie. Darüber hinaus ist eine verlässliche Teilnahme an engmaschigen Nachsorgeuntersuchungen sowohl im jeweiligen Adipositaszentrum als auch beim zuständigen Hausarzt unabdingbar, um eventuell auftretende Komplikationen und Mangelerscheinungen frühzeitig zu erkennen und behandeln zu können. Vitamin- und Nährstoffmängel sind selten und können bislang gut mittels Substitutionstherapie behoben werden. Zusammenfassend kann gesagt werden, dass die chirurgische Intervention in Form des laparoskopischen Magenbypass bei morbider Adipositas eine überaus effektive, mit geringen Komplikationen verbundene, risikoarme Therapieoption darstellt. N2 - Background: The choice between different bariatric procedures for each patient is an important question in bariatric surgery. In this article, we explain criteria for patient selection for laparoscopic Roux-en-Y gastric bypass at the Obesity Center Wuerzburg and compare the corresponding outcomes for these selection criteria. Methods: 60 consecutive patients underwent gastric bypass surgery (34 female, 26 male; mean age 45.1 – 10.2 years). Mean preoperative BMI was 53.7 – 8.7 kg/m2. Selection criteria were age > 40, male sex, BMI > 50, metabolic syndrome, and/or reduced compliance. Results: 42 patients (70%) were >40 years old, 26 patients (43%) were male, 42 patients (70%) had a BMI > 50, and 28 patients had a metabolic syndrome (47%). 10 out of these 42 patients were reoperated after failed gastric banding. Overall weight loss was 43.7 – 18.7 kg, BMI loss was 15.0 – 6.4 kg/m2, and excess body weight loss (EBWL) was 54.3 – 19.7%. There were 34 patients with an EBWL of (50%. Age, sex, and presence or absence of metabolic syndrome were irrelevant for postoperative weight loss. Although the EBWL was slightly higher in patients with a BMI < 50, patients with a BMI > 50 lost significantly more weight. Discussion: The indication for a gastric bypass may be substantiated by the higher weight reduction in patients with a BMI > 50. Other selection criteria had no influence on the postoperative outcome. KW - Magenbypass KW - Fettsucht KW - Adipositas KW - bariatrische KW - Chirurgie KW - Magenbypass KW - Malnutration KW - Roux-en-Y KW - bariatric KW - surgery KW - Roux-en-Y KW - gastric bypass KW - malnutrition Y1 - 2011 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-70453 ER - TY - JOUR A1 - Gaab, Christine A1 - Adolph, Jonas E. A1 - Tippelt, Stephan A1 - Mikasch, Ruth A1 - Obrecht, Denise A1 - Mynarek, Martin A1 - Rutkowski, Stefan A1 - Pfister, Stefan M. A1 - Milde, Till A1 - Witt, Olaf A1 - Bison, Brigitte A1 - Warmuth-Metz, Monika A1 - Kortmann, Rolf-Dieter A1 - Dietzsch, Stefan A1 - Pietsch, Torsten A1 - Timmermann, Beate A1 - Sträter, Ronald A1 - Bode, Udo A1 - Faldum, Andreas A1 - Kwiecien, Robert A1 - Fleischhack, Gudrun T1 - Local and systemic therapy of recurrent medulloblastomas in children and adolescents: results of the P-HIT-REZ 2005 Study JF - Cancers N2 - Recurrent medulloblastomas are associated with survival rates <10%. Adequate multimodal therapy is being discussed as having a major impact on survival. In this study, 93 patients with recurrent medulloblastoma treated in the German P-HIT-REZ 2005 Study were analyzed for survival (PFS, OS) dependent on patient, disease, and treatment characteristics. The median age at the first recurrence was 10.1 years (IQR: 6.9–16.1). Median PFS and OS, at first recurrence, were 7.9 months (CI: 5.7–10.0) and 18.5 months (CI: 13.6–23.5), respectively. Early relapses/progressions (<18 months, n = 30/93) found mainly in molecular subgroup 3 were associated with markedly worse median PFS (HR: 2.34) and OS (HR: 3.26) in regression analyses. A significant survival advantage was found for the use of volume-reducing surgery as well as radiotherapy. Intravenous chemotherapy with carboplatin and etoposide (ivCHT, n = 28/93) showed improved PFS and OS data and the best objective response rate (ORR) was 66.7% compared to oral temozolomide (oCHT, n = 47/93) which was 34.8%. Intraventricular (n = 43) as well as high-dose chemotherapy (n = 17) at first relapse was not related to a significant survival benefit. Although the results are limited due to a non-randomized study design, they may serve as a basis for future treatment decisions in order to improve the patients' survival. KW - medulloblastoma KW - refractory KW - recurrent KW - children KW - chemotherapy KW - surgery KW - radiotherapy KW - re-irradiation KW - intraventricular therapy Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-254809 SN - 2072-6694 VL - 14 IS - 3 ER - TY - JOUR A1 - Kandels, Daniela A1 - Pietsch, Torsten A1 - Bison, Brigitte A1 - Warmuth‐Metz, Monika A1 - Thomale, Ulrich‐Wilhelm A1 - Kortmann, Rolf‐Dieter A1 - Timmermann, Beate A1 - Hernáiz Driever, Pablo A1 - Witt, Olaf A1 - Schmidt, René A1 - Gnekow, Astrid K. T1 - Loss of efficacy of subsequent nonsurgical therapy after primary treatment failure in pediatric low‐grade glioma patients—Report from the German SIOP‐LGG 2004 cohort JF - International Journal of Cancer N2 - First‐line treatment of pediatric low‐grade glioma using surgery, radio‐ or chemotherapy fails in a relevant proportion of patients. We analyzed efficacy of subsequent surgical and nonsurgical therapies of the German cohort of the SIOP‐LGG 2004 study (2004‐2012, 1558 registered patients; median age at diagnosis 7.6 years, median observation time 9.2 years, overall survival 98%/96% at 5/10 years, 15% neurofibromatosis type 1 [NF1]). During follow‐up, 1078/1558 patients remained observed without (n = 217), with 1 (n = 707), 2 (n = 124) or 3 to 6 (n = 30) tumor volume reductions; 480/1558 had 1 (n = 332), 2 (n = 80), 3 or more (n = 68) nonsurgical treatment‐lines, accompanied by up to 4 tumor‐reductive surgeries in 215/480; 265/480 patients never underwent any neurosurgical tumor volume reduction (163/265 optic pathway glioma). Patients with progressing tumors after first‐line adjuvant treatment were at increased risk of suffering further progressions. Risk factors were young age (<1 year) at start of treatment, tumor dissemination or progression within 18 months after start of chemotherapy. Progression‐free survival rates declined with subsequent treatment‐lines, yet remaining higher for patients with NF1. In non‐NF1‐associated tumors, vinblastine monotherapy vs platinum‐based chemotherapy was noticeably less effective when used as second‐line treatment. Yet, for the entire cohort, results did not favor a certain sequence of specific treatment options. Rather, all can be aligned as a portfolio of choices which need careful balancing of risks and benefits. Future molecular data may predict long‐term tumor biology. KW - chemotherapy KW - pediatric low‐grade glioma KW - progression KW - radiotherapy KW - surgery Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-216130 VL - 147 IS - 12 SP - 3471 EP - 3489 ER - TY - JOUR A1 - Judd, L. A1 - Hof, L. A1 - Beladdale, L. A1 - Friederich, P. A1 - Thoma, J. A1 - Wittmann, M. A1 - Zacharowski, K. A1 - Meybohm, P. A1 - Choorapoikayil, S. T1 - Prevalence of pre-operative anaemia in surgical patients: a retrospective, observational, multicentre study in Germany JF - Anaesthesia N2 - Anaemia is a risk factor for several adverse postoperative outcomes. Detailed data about the prevalence of anaemia are not available over a long time-period in Germany. In this retrospective, observational, multicentre study, patients undergoing surgery in March in 2007, 2012, 2015, 2017 and 2019 were studied. The primary objective was the prevalence of anaemia at hospital admission. The secondary objectives were the association between anaemia and the number of units of red blood cells transfused, length of hospital stay and in-hospital mortality. A total of 23,836 patients were included from eight centres. The prevalence of pre-operative anaemia in patients aged ≥ 18 years decreased slightly from 37% in 2007 to 32.5% in 2019 (p = 0.01) and increased in patients aged ≤ 18 years from 18.8% in 2007 to 26.4% in 2019 (p > 0.001). The total amount of blood administered per 1000 patients decreased from 671.2 units in 2007 to 289.0 units in 2019. Transfusion rates in anaemic patients declined from 33.8% in 2007 to 19.1% in 2019 (p < 0.001) and in non-anaemic patients from 8.4% in 2007 to 3.4% in 2019 (p < 0.001). Overall, the mortality rate remained constant over the years: 2.9% in 2007, 2.1% in 2012, 2.5% in 2015, 1.9% in 2017 and 2.5% in 2019. In the presence of anaemia, mortality was significantly increased compared with patients without anaemia (OR 5.27 (95%CI 4.13–6.77); p < 0.001). Red blood cell transfusion was associated with an increased risk of mortality (OR 14.98 (95%CI 11.83–19.03); p < 0.001). Using multivariable linear regression analysis with fixed effects, we found that pre-operative anaemia (OR 2.08 (95%CI 1.42–3.05); p < 0.001) and red blood cell transfusion (OR 4.29 (95%CI 3.09–5.94); p < 0.001) were predictors of mortality but not length of stay (0.99 (95%CI 0.98–1.00) days; p = 0.12) and analysed years (2007 vs. 2019: OR 1.49 (95%CI 0.86–2.69); p = 0.07). Pre-operative anaemia affects more than 30% of surgical patients in Germany and multidisciplinary action is urgently required to reduce adverse outcomes. KW - anaemia KW - surgery KW - prevalence Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-318199 VL - 77 IS - 11 SP - 1209 EP - 1218 ER - TY - JOUR A1 - Jordan, Martin C. A1 - Jovic, Sebastian A1 - Gilbert, Fabian A1 - Kunz, Andreas A1 - Ertl, Maximilian A1 - Strobl, Ute A1 - Jakubietz, Rafael G. A1 - Jakubietz, Michael G. A1 - Meffert, Rainer H. A1 - Fuchs, Konrad F. T1 - Qualitätssteigerung der Abrechnungsprüfung durch Smartphone-basierte Fotodokumentation in der Unfall-, Hand-, und Plastischen Chirurgie JF - Der Unfallchirurg N2 - Hintergrund Die Fotodokumentation von offenen Frakturen, Wunden, Dekubitalulzera, Tumoren oder Infektionen ist ein wichtiger Bestandteil der digitalen Patientenakte. Bisher ist unklar, welchen Stellenwert diese Fotodokumentation bei der Abrechnungsprüfung durch den Medizinischen Dienst der Krankenkassen (MDK) hat. Fragestellung Kann eine Smartphone-basierte Fotodokumentation die Verteidigung von erlösrelevanten Diagnosen und Prozeduren sowie der Verweildauer verbessern? Material und Methoden Ausstattung der Mitarbeiter mit digitalen Endgeräten (Smartphone/Tablet) in den Bereichen Notaufnahme, Schockraum, OP, Sprechstunden sowie auf den Stationen. Retrospektive Auswertung der Abrechnungsprüfung im Jahr 2019 und Identifikation aller Fallbesprechungen, in denen die Fotodokumentation eine Erlösveränderung bewirkt hat. Ergebnisse Von insgesamt 372 Fallbesprechungen half die Fotodokumentation in 27 Fällen (7,2 %) zur Bestätigung eines Operationen- und Prozedurenschlüssels (OPS) (n = 5; 1,3 %), einer Hauptdiagnose (n = 10; 2,7 %), einer Nebendiagnose (n = 3; 0,8 %) oder der Krankenhausverweildauer (n = 9; 2,4 %). Pro oben genanntem Fall mit Fotodokumentation ergab sich eine durchschnittliche Erlössteigerung von 2119 €. Inklusive Aufwandpauschale für die Verhandlungen wurde somit ein Gesamtbetrag von 65.328 € verteidigt. Diskussion Der Einsatz einer Smartphone-basierten Fotodokumentation kann die Qualität der Dokumentation verbessern und Erlöseinbußen bei der Abrechnungsprüfung verhindern. Die Implementierung digitaler Endgeräte mit entsprechender Software ist ein wichtiger Teil des digitalen Strukturwandels in Kliniken. N2 - Background Photographic documentation of wounds, decubitus ulcers, tumors, open fractures and infections is an important part of digital patient files. It is unclear whether the photographic documentation has an effect on medical accounting with health insurance companies. Objective It was hypothesized that Smartphone-based systematic photographic documentation can improve the confirmation of proceeds-relevant diagnoses and procedures as well as the duration. Material and methods Staff in the emergency room, operating theater, outpatient clinic and on the wards were equipped with digital devices (Smartphone, tablet) including a photo-app. Medical accounting with the health insurance companies and identification of all case conferences in which the photographic documentation had effected a change in proceeds were analyzed for 2019 in a retrospective manner. Results Overall, 372 cases were discussed of which 27 cases were affected by the digital photographic documentation. Photographic documentation was used for clarification of the operative procedure (n = 5), primary diagnosis (n = 10), secondary diagnosis (n = 3), and length of hospitalization (n = 9). An average of 2119 € was negotiated and added per case affected by photographic documentation. Hereby, a level 1 trauma center gained an estimated 65,328 € in revenue. Discussion The use of Smartphone based photographic documentation can improve the overall quality of patient files and thus avoid loss of revenue. The implementation of digital devices with corresponding software is an important component of the digital structural change in hospitals. KW - Digitalisierung KW - Gesundheits-App KW - Künstliche Intelligenz KW - Plattform KW - Strukturwandel KW - artificial intelligence KW - database KW - digital transformation KW - photo app KW - surgery Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-232415 SN - 0177-5537 VL - 124 ER - TY - JOUR A1 - Altieri, Barbara A1 - La Salvia, Anna A1 - Modica, Roberta A1 - Marciello, Francesca A1 - Mercier, Olaf A1 - Filosso, Pier Luigi A1 - de Latour, Bertrand Richard A1 - Giuffrida, Dario A1 - Campione, Severo A1 - Guggino, Gianluca A1 - Fadel, Elie A1 - Papotti, Mauro A1 - Colao, Annamaria A1 - Scoazec, Jean-Yves A1 - Baudin, Eric A1 - Faggiano, Antongiulio T1 - Recurrence-free survival in early and locally advanced large cell neuroendocrine carcinoma of the lung after complete tumor resection JF - Journal of Personalized Medicine N2 - Background: Large Cell Neuroendocrine Carcinoma (LCNEC) is a rare subtype of lung cancer with poor clinical outcomes. Data on recurrence-free survival (RFS) in early and locally advanced pure LCNEC after complete resection (R0) are lacking. This study aims to evaluate clinical outcomes in this subgroup of patients and to identify potential prognostic markers. Methods: Retrospective multicenter study including patients with pure LCNEC stage I-III and R0 resection. Clinicopathological characteristics, RFS, and disease-specific survival (DSS) were evaluated. Univariate and multivariate analyses were performed. Results: 39 patients (M:F = 26:13), with a median age of 64 years (44–83), were included. Lobectomy (69.2%), bilobectomy (5.1%), pneumonectomy (18%), and wedge resection (7.7%) were performed mostly associated with lymphadenectomy. Adjuvant therapy included platinum-based chemotherapy and/or radiotherapy in 58.9% of cases. After a median follow-up of 44 (4–169) months, the median RFS was 39 months with 1-, 2- and 5-year RFS rates of 60.0%, 54.6%, and 44.9%, respectively. Median DSS was 72 months with a 1-, 2- and 5-year rate of 86.8, 75.9, and 57.4%, respectively. At multivariate analysis, age (cut-off 65 years old) and pN status were independent prognostic factors for both RFS (HR = 4.19, 95%CI = 1.46–12.07, p = 0.008 and HR = 13.56, 95%CI 2.45–74.89, p = 0.003, respectively) and DSS (HR = 9.30, 95%CI 2.23–38.83, p = 0.002 and HR = 11.88, 95%CI 2.28–61.84, p = 0.003, respectively). Conclusion: After R0 resection of LCNEC, half of the patients recurred mostly within the first two years of follow-up. Age and lymph node metastasis could help to stratify patients for adjuvant therapy. KW - neuroendocrine tumor KW - LCNEC KW - pulmonary cancer KW - prognostic marker KW - prognosis KW - survival KW - lymph nodes KW - age KW - surgery KW - adjuvant therapy Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-304000 SN - 2075-4426 VL - 13 IS - 2 ER - TY - JOUR A1 - Stangl, Stephanie A1 - Popp, Maria A1 - Reis, Stefanie A1 - Sitter, Magdalena A1 - Saal-Bauernschubert, Lena A1 - Schießer, Selina A1 - Kranke, Peter A1 - Choorapoikayil, Suma A1 - Weibel, Stephanie A1 - Meybohm, Patrick T1 - Reported outcomes in patients with iron deficiency or iron deficiency anemia undergoing major surgery: a systematic review of outcomes JF - Systematic Reviews N2 - Background Iron deficiency (ID) is the leading cause of anemia worldwide. The prevalence of preoperative ID ranges from 23 to 33%. Preoperative anemia is associated with worse outcomes, making it important to diagnose and treat ID before elective surgery. Several studies indicated the effectiveness of intravenous iron supplementation in iron deficiency with or without anemia (ID(A)). However, it remains challenging to establish reliable evidence due to heterogeneity in utilized study outcomes. The development of a core outcome set (COS) can help to reduce this heterogeneity by proposing a minimal set of meaningful and standardized outcomes. The aim of our systematic review was to identify and assess outcomes reported in randomized controlled trials (RCTs) and observational studies investigating iron supplementation in iron-deficient patients with or without anemia. Methods We searched MEDLINE, CENTRAL, and ClinicalTrials.gov systematically from 2000 to April 1, 2022. RCTs and observational studies investigating iron supplementation in patients with a preoperative diagnosis of ID(A), were included. Study characteristics and reported outcomes were extracted. Outcomes were categorized according to an established outcome taxonomy. Quality of outcome reporting was assessed with a pre-specified tool. Reported clinically relevant differences for sample size calculation were extracted. Results Out of 2898 records, 346 underwent full-text screening and 13 studies (five RCTs, eight observational studies) with sufficient diagnostic inclusion criteria for iron deficiency with or without anemia (ID(A)) were eligible. It is noteworthy to mention that 49 studies were excluded due to no confirmed diagnosis of ID(A). Overall, 111 outcomes were structured into five core areas including nine domains. Most studies (92%) reported outcomes within the ‘blood and lymphatic system’ domain, followed by “adverse event” (77%) and “need for further resources” (77%). All of the latter reported on the need for blood transfusion. Reported outcomes were heterogeneous in measures and timing. Merely, two (33%) of six prospective studies were registered prospectively of which one (17%) showed no signs of selective outcome reporting. Conclusion This systematic review comprehensively depicts the heterogeneity of reported outcomes in studies investigating iron supplementation in ID(A) patients regarding exact definitions and timing. Our analysis provides a systematic base for consenting to a minimal COS. Systematic review registration PROSPERO CRD42020214247 KW - iron deficiency KW - iron deficiency anemia KW - core outcome set KW - outcome reporting KW - data harmonization KW - preoperative setting KW - perioperative setting KW - surgery Y1 - 2024 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-357213 VL - 13 ER - TY - THES A1 - Wennmann, Andreas T1 - Retrospektiver Vergleich der präoperativen Lokalisationsdiagnostik mit der intraoperativen Detektion von Nebenschilddrüsen-Adenomen sowie dem perioperativen Verlauf bei Patienten/Patientinnen mit primärem Hyperparathyreoidismus T1 - Retrospective comparison of preoperative localization diagnostics with intraoperative detection of parythyroid adenomas as well as perioperative course in patients with primary hyperparathyroidism N2 - Die Exstirpation erkrankter Nebenschilddrüsen (NSD) ist die einzige kurative Therapie des primären Hyperparathyreoidismus (pHPT). Die präoperative Detektion der dem pHPT zugrunde liegenden NSD-Adenome durch eine adäquate Lokalisationsdiagnostik stellt eine wichtige Säule bei der Operationsplanung dar. Angesichts der umfangreichen diagnostischen Möglichkeiten ist noch nicht abschließend beantwortet, wie viel und welche Diagnostik mit hoher Wahrscheinlichkeit zur erfolgreichen Lokalisation von NSD-Adenomen führt und ob/wie diese den perioperativen Verlauf beeinflusst. Die Beantwortung dieser Fragen war das Hauptziel der vorliegenden Arbeit. Es handelt sich um eine monozentrische, retrospektive Datenanalyse anhand des Kollektivs des Universitätsklinikums Würzburg (UKW) der Jahre 2005 bis 2017. Nach Datenextraktion aller Patienten/Patientinnen mit Hyperparathyreoidismus aus dem Dokumentationssystem des UKW erfolgten die deskriptiven und statistischen Auswertungen mittels Excel und SPSS. Insgesamt wurden im untersuchten Zeitraum 467 Patienten/Patientinnen aufgrund eines pHPT operiert. NSD-Sono und NSD-Szinti waren die am häufigsten durchgeführten Lokalisationsdiagnostika mit Sensitivitäten von 61,5 % bzw. 66,3 % für die Seite. Bei der Etagen-Blutentnahme lag die Sensitivität bei 100 %; bei der MRT bei 47,4 % und bei der 11Kohlenstoff-Methionin-Positronenemissionstomographie/Computertomographie (11C-Methionin-PET/CT) bei 58,8 %. Durch zusätzliche Diagnostik konnte nicht grundsätzlich eine Erhöhung der Treffsicherheit erreicht werden. Die Analyse der perioperativen Parameter zeigte, dass das Alter der Operierten positiv mit der Operationsdauer, der Krankenhausaufenthaltsdauer und dem Auftreten postoperativer Hypocalcämien korrelierte. Die Einnahme eines Thrombozytenaggregationshemmers führte zu einer verlängerten Krankenhausaufenthaltsdauer. Die therapeutische Antikoagulation war ein Risikofaktor in Bezug auf längere OP-Dauern und das Auftreten von Nachblutungen. Eine zusätzlich zur Parathyreoidektomie durchgeführte Sanierung der Schilddrüse war mit einer erhöhten Rate an postoperativen Hypocalcämien vergesellschaftet. Zusammenfassend zeigen die vorliegenden Daten, dass nach initial vermeintlich erfolgreicher Detektion eines NSD-Adenoms mit NSD-Sono oder NSD-Szinti eine weiterführende Lokalisationsdiagnostik nicht sinnvoll ist. Nach initial erfolgloser NSD-Sono oder NSD-Szinti dagegen ist die Durchführung einer 11C-Methionin-PET/CT zu erwägen. N2 - Extirpation of diseased parathyroid glands is the only curative therapy for primary hyperparathyroidism (pHPT). Preoperative localization of parathyroid adenomas underlying pHPT by appropriate localization diagnostics is important for planning surgery. Considering extensive diagnostic possibilities, it is not completely clear yet how much and which diagnostics with high probability will detect parathyroid adenomas correctly and if/how it influences perioperative course. Answering these questions was main aim of the present work. It is a monocentric, retrospective data analysis of the collective of Universitätsklinikum Würzburg (UKW) from 2005 - 2017. After data extraction of all patients with hyperparathyroidism out of documentation system of UKW, descriptive and statistic evaluations were made by Excel and SPSS. All in all, 467 patients underwent surgery for pHPT during the investigated timespace. Parathyroid-ultrasound and parathyroid-scintigraphy were the localization techniques used most frequently with sensitivities of 61,5 % and 66,3 % respectively for correct localization of the side. Sensitivity of selective venous sampling was 100 %, of MRI was 47,4 % and of 11carbon methionine positron emission tomography/computed tomography (11C methionine PET/CT) was 58,8 %. Using additional diagnostics, the detection rate could not necessarily be increased. Analysis of perioperative parameters showed that age was positively correlated with duration of surgery, length of stay at the hospital and postoperative hypocalcaemias. Inhibitors of platelet aggregation led to longer duration of hospitalisation stay. Therapeutic anticoagulation was risk factor for longer duration of surgery and appearance of postoperative bleedings. Additional to parathyroid gland performed thyroid surgery was associated with postoperative hypocalcaemias. In summary the present data show that after supposedly successful parathyroid ultrasound or parathyroid scintigraphy, no further localization diagnostics is indicated. After initially unsuccessful parathyroid ultrasound or parathyroid scintigraphy however, 11C methionine PET/CT should be considered. KW - Primärer Hyperparathyreoidismus KW - Epithelkörperchen KW - Lokalisation KW - Operation KW - Verlauf KW - primary hyperparathyroidism KW - parathyroid glands KW - localization KW - surgery KW - course Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-249895 ER - TY - JOUR A1 - El Majdoub, Faycal A1 - Hunsche, Stefan A1 - Igressa, Alhadi A1 - Kocher, Martin A1 - Sturm, Volker A1 - Maarouf, Mohammad T1 - Stereotactic LINAC-Radiosurgery for Glomus Jugulare Tumors: A Long-Term Follow-Up of 27 Patients JF - PLoS ONE N2 - Background The optimal treatment of glomus jugulare tumors (GJTs) remains controversial. Due to the critical location, microsurgery still provides high treatment-related morbidity and a decreased quality of life. Thus, we performed stereotactical radiosurgery (SRS) for the treatment of GJTs and evaluated the long-term outcome. Methods Between 1991 and 2011, 32 patients with GJTs underwent SRS using a linear accelerator (LINAC) either as primary or salvage therapy. Twenty-seven patients (median age 59.9 years, range 28.7-79.9 years) with a follow-up greater than five years (median 11 years, range 5.3-22.1 years) were selected for retrospective analysis. The median therapeutic single dose applied to the tumor surface was 15 Gy (range 11-20 Gy) and the median tumor volume was 9.5 ml (range 2.8-51 ml). Results Following LINAC-SRS, 10 of 27 patients showed a significant improvement of their previous neurological complaints, whereas 12 patients remained unchanged. Five patients died during follow-up due to old age or other, not treatment-related reasons. MR-imaging showed a partial remission in 12 and a stable disease in 15 patients. No tumor progression was observed. The actuarial overall survival rates after five, ten and 20 years were 100%, 95.2% and 79.4%, respectively. Conclusions Stereotactic LINAC-Radiosurgery can achieve an excellent long-term tumor control beside a low rate of morbidity in the treatment of GJTs. It should be considered as an alternative therapy regime to surgical resection or fractionated external beam radiation either as primary, adjuvant or salvage therapy. KW - gamma knife radiosurgery KW - accelerator based radiosurgery KW - radiation therapy KW - temporal bone KW - skull base KW - surgery KW - paragangliomas KW - management KW - radiotherapy KW - head Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-151717 VL - 10 IS - 6 ER - TY - JOUR A1 - Tecle, Nyat-Eyob A1 - Hackenberg, Stephan A1 - Scheich, Matthias A1 - Scherzad, Agmal A1 - Hagen, Rudolf A1 - Gehrke, Thomas T1 - Surgical management of lateral neck abscesses in children: a retrospective analysis of 100 cases JF - European Journal of Pediatrics N2 - Cervical abscesses are relatively common infections in pediatric patients. There is an ongoing debate about the necessity and time point of surgical drainage. The identification of a focus of infection might play an important role in facilitating a therapeutic decision. In a retrospective study, 100 pediatric patients aged 1–18 years who underwent incision and drainage of a lateral cervical abscess at our institution were analyzed. Patients were divided into two groups based on whether a focus of infection could be identified or not. Data collection included patient characteristics, microbiological results, antibiotic regimen, and clinical course. A focus of infection was found in 29% (29/100) of the patients, most frequently in the tonsils. A causative microorganism was found in 75% (75/100) of all patients, with Staphylococcus aureus and Streptococcus pyogenes being the most common pathogens. All patients received an empiric antibiotic therapy in addition to surgery. Antibiotic medication was changed in 31% in both groups (9/29 with a focus of infection and 22/71 without a focus of infection) during therapy. Children without an identified focus of infection generally were younger and had more comorbidities reducing immune response while also showing differences in the pathogens involved. There were no complications associated to surgery or antibiotic therapy in any of the patients involved. Conclusion: Children with an identified focus of infection show several differences compared to those with isolated lateral abscesses, especially regarding the microorganisms involved. But the focus of infection seems not to have an impact on patient’s outcome. What is Known: • Neck abscesses are a relatively common disease in the pediatric population and may cause serious complications. • Therapy in general consists of intravenous antibiotics with or without surgery. What is New: • The focus identification has no impact on patient’s outcome. • Children with an identified focus of infection show several differences compared to those with isolated lateral abscesses, especially regarding their medical history, age, and the microorganisms involved. KW - lateral neck abscesses KW - children KW - focus of infection KW - surgery Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-324179 VL - 182 IS - 1 ER - TY - JOUR A1 - Jakubietz, Rafael G. A1 - Jakubietz, Danni F. A1 - Horch, Raymund E. A1 - Gruenert, Joerg G. A1 - Meffert, Rainer H. A1 - Jakubietz, Michael G. T1 - The microvascular peroneal artery perforator flap as a "lifeboat" for pedicled flaps JF - Plastic and Reconstructive Surgery – Global Open N2 - Background: Pedicled perforator flaps have expanded reconstructive options in extremity reconstruction. Despite preoperative mapping, intraoperative findings may require microvascular tissue transfer when no adequate perforators can be found. The free peroneal artery perforator flap may serve as a reliable back-up plan in small defects. Methods: In 16 patients with small soft tissue defects on the upper and lower extremities, perforator-based propeller flaps were planned. The handheld Doppler device was used to localize potential perforators for a propeller flap in close proximity to the defect. Perforators of the proximal peroneal artery were also marked to allow conversion to microvascular tissue transfer. Results: In 6 cases, no adequate perforators were found intraoperatively. In 4 patients, the peroneal artery perforator flap was harvested and transferred. The pedicle length did not exceed 4 cm. No flap loss occurred. Conclusions: When no adequate perforator capable of nourishing a propeller flap can be found intraoperatively, the free peroneal artery flap is a good option to reconstruct small soft tissue defects in the distal extremities. The short vascular pedicle is less ideal in cases with a large zone of injury requiring a more distant site of anastomosis or when recipient vessels are located in deeper tissue planes. KW - surgery Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-202233 VL - 7 IS - 9 ER - TY - JOUR A1 - Kelm, Matthias A1 - Germer, Christoph-Thomas A1 - Schlegel, Nicolas A1 - Flemming, Sven T1 - The revival of surgery in Crohn's disease — early intestinal resection as a reasonable alternative in localized ileitis JF - Biomedicines N2 - Crohn's disease (CD) represents a heterogeneous and complex disease with no curative therapeutic option available to date. Current therapy is mainly antibody-based focusing on the immune system while other treatment alternatives such as surgery are considered to be “last options”. However, medical therapy for CD results in mild to severe side effects in a relevant amount of patients and some patients do not respond to the medication. Following that, quality of life is often significantly reduced in this patient cohort, thus, therapeutic alternatives are urgently needed. Updated evidence has revealed that surgery such as ileocecal resection (ICR) might be a potential therapeutic option in case of localized terminal ileitis since resection at early time points improves quality of life and significantly reduces the postoperative need for immunosuppressive medication with low rates of morbidity. In addition, new surgical approaches such as Kono-S anastomosis or inclusion of the mesentery result in significantly reduced rates of disease recurrence and reoperation. Based on the new evidence, the goal of this review is to provide an update on the role of surgery as a reasonable alternative to medical therapy in the interdisciplinary treatment of patients with CD. KW - surgery KW - Crohn's disease KW - terminal ileitis KW - inflammatory bowel disease KW - surgical outcome Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-246296 SN - 2227-9059 VL - 9 IS - 10 ER - TY - JOUR A1 - Paschke, Ralf A1 - Lincke, Thomas A1 - Müller, Stefan P. A1 - Kreissl, Michael C. A1 - Dralle, Henning A1 - Fassnacht, Martin T1 - The Treatment of Well-Differentiated Thyroid Carcinoma JF - Deutsches Ärzteblatt International N2 - Background: Recent decades have seen a rise in the incidence of well-differentiated (mainly papillary) thyroid carcinoma around the world. In Germany, the age-adjusted incidence of well-differentiated thyroid carcinoma in 2010 was 3.5 per 100 000 men and 8.7 per 100 000 women per year. Method: This review is based on randomized, controlled trials and multicenter trials on the treatment of well-differentiated thyroid carcinoma that were retrieved by a selective literature search, as well as on three updated guidelines issued in the past two years. Results: The recommended extent of surgical resection depends on whether the tumor is classified as low-risk or high-risk, so that papillary microcar cinomas, which carry a highly favorable prognosis, will not be overtreated. More than 90% of localized, well-differentiated thyroid carcinomas can be cured with a combination of surgery and radioactive iodine therapy. Radio active iodine therapy is also effective in the treatment of well-differentiated thyroid carcinomas with distant metastases, yielding a 10-year survival rate of 90%, as long as there is good iodine uptake and the tumor goes into remission after treatment; otherwise, the 10-year survival rate is only 10%. In the past two years, better treatment options have become available for radioactive-iodine-resistant thyroid carcinoma. Phase 3 studies of two different tyrosine kinase inhibitors have shown that either one can markedly prolong progression-free survival, but not overall survival. Their more common clinically significant side effects are hand-foot syndrome, hypertension, diarrhea, proteinuria, and weight loss. Conclusion: Slow tumor growth, good resectability, and susceptibility to radioactive iodine therapy lend a favorable prognosis to most cases of well-differentiated thyroid carcinoma. The treatment should be risk-adjusted and interdisciplinary, in accordance with the current treatment guidelines. Even metastatic thyroid carcinoma has a favorable prognosis as long as there is good iodine uptake. The newly available medical treatment options for radioactive-iodine-resistant disease need to be further studied. KW - BRAF(V600E) mutation KW - distant metastases KW - papillary KW - guidelines KW - surgery KW - dissection KW - management KW - association KW - cancer KW - radioiodine therapy Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-151636 VL - 112 SP - 452 EP - 458 ER - TY - JOUR A1 - Porubsky, Stefan A1 - Popovic, Zoran V. A1 - Badve, Sunil A1 - Banz, Yara A1 - Berezowska, Sabina A1 - Borchert, Dietmar A1 - Brüggemann, Monika A1 - Gaiser, Timo A1 - Graeter, Thomas A1 - Hollaus, Peter A1 - Huettl, Katrin S. A1 - Kotrova, Michaela A1 - Kreft, Andreas A1 - Kugler, Christian A1 - Lötscher, Fabian A1 - Möller, Burkhard A1 - Ott, German A1 - Preissler, Gerhard A1 - Roessner, Eric A1 - Rosenwald, Andreas A1 - Ströbel, Philipp A1 - Marx, Alexander T1 - Thymic hyperplasia with lymphoepithelial sialadenitis (LESA)-like features: strong association with lymphomas and non-myasthenic autoimmune diseases JF - Cancers N2 - Thymic hyperplasia (TH) with lymphoepithelial sialadenitis (LESA)-like features (LESA-like TH) has been described as a tumor-like, benign proliferation of thymic epithelial cells and lymphoid follicles. We aimed to determine the frequency of lymphoma and autoimmunity in LESA-like TH and performed retrospective analysis of cases with LESA-like TH and/or thymic MALT-lymphoma. Among 36 patients (21 males) with LESA-like TH (age 52 years, 32–80; lesion diameter 7.0 cm, 1–14.5; median, range), five (14%) showed associated lymphomas, including four (11%) thymic MALT lymphomas and one (3%) diffuse large B-cell lymphoma. One additional case showed a clonal B-cell-receptor rearrangement without evidence of lymphoma. Twelve (33%) patients (7 women) suffered from partially overlapping autoimmune diseases: systemic lupus erythematosus (n = 4, 11%), rheumatoid arthritis (n = 3, 8%), myasthenia gravis (n = 2, 6%), asthma (n = 2, 6%), scleroderma, Sjögren syndrome, pure red cell aplasia, Grave’s disease and anti-IgLON5 syndrome (each n = 1, 3%). Among 11 primary thymic MALT lymphomas, remnants of LESA-like TH were found in two cases (18%). In summary, LESA-like TH shows a striking association with autoimmunity and predisposes to lymphomas. Thus, a hematologic and rheumatologic workup should become standard in patients diagnosed with LESA-like TH. Radiologists and clinicians should be aware of LESA-like TH as a differential diagnosis for mediastinal mass lesions in patients with autoimmune diseases. KW - autoimmune disease KW - imaging KW - LESA KW - lymphoma KW - myasthenia KW - pathology KW - surgery KW - thymus KW - thymic epithelial tumor KW - thymitis Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-223049 SN - 2072-6694 VL - 13 IS - 2 ER - TY - THES A1 - Günster, Simone Andrea T1 - Validierung eines klinischen Data Warehouses: Einsatz und Möglichkeiten in der Viszeralchirurgie T1 - Validation of a clinical data warehouse: potential applications in visceral surgery N2 - Einleitung: In Zeiten des digitalen Fortschritts und wachsender Speicherkapazitäten wird es möglich, immer größere Datenmengen zu verarbeiten. Gleichzeitig besteht der Wunsch, aus diesen Daten neue Informationen im Sinne des „Information retrieval“ zu gewinnen. PaDaWaN ist ein parametrisierbares Data Warehouse Framework zur effizienten Abfrage und Auswertung homogener und heterogener Datenbestände, das 2011 an der Universität Würzburg entwickelt wurde. Methoden: Zur Validierung des Data Warehouses in der Viszeralchirurgie wurden die automatisiert generierten Daten aus PaDaWaN mit den manuell erhobenen Registerdaten des EuraHS Registers verglichen. Eingeschlossen wurden Patienten mit der Diagnose einer inzisionalen oder primär ventralen Hernie (n=510). Hierfür wurden Informationen zu Diagnosen, Operationen und die intraoperativ verwendeten Materialien aus strukturierten und unstrukturierten Datenquellen des CIS ausgelesen. Das Maß der Übereinstimmung wurde mittels Cohens Kappa-Koeffizienten berechnet (IBM SPSS Statistics 24). Ergebnisse: Im Rahmen der Studie konnten Diskrepanzen zwischen strukturierten Datenquellen (ICD-10 Codes, OPS Codes) und unstrukturierten Datenquallen (Arztbriefe, Operationsberichte) aufgedeckt werden. Unstimmigkeiten in der ICD-10 Klassifikation für primär ventrale und inzisionale Hernien führten zu einer deutlichen Unterschätzung der inzisionalen umbilikalen Hernien. Sehr gute Übereinstimmungen wurden in den Kategorien Netzimplantation in IPOM-Technik, Underlay- und Sublay-Position erreicht. Faktoren, die die Konkordanz der Datensätze beeinflussten, waren: Erfassung von Vordiagnosen, Voroperationen, mangelndes Erkennen von Negierungen und die Verwendung mehrerer Netze während einer Operation. Klassifikationen wie die "Dietz-Klassifikation" konnten automatisch erkannt und in ihre Bestandteile zerlegt werden. Fazit: Durch die Etablierung von Data Warehousing als Plattform für die klinische Forschung können Daten in Zukunft schneller strukturiert und generiert werden. Durch die dynamische tägliche automatisierte Datenaktualisierung kann das klinische Personal Behandlungskonzepte und Ergebnisse schneller validieren und bewerten. Darüber hinaus können Empfehlungen für zukünftige medizinische Dokumentation gegeben werden, um die Informationsextraktion von PaDaWaN zu verbessern. Die Ergebnisse dieser Studie zeigen deutliche Diskrepanzen zwischen strukturierten und unstrukturierten Datenquellen. Vorhandene Register und Daten des CIS können zukünftig im Sinne einer internen Validierung verifiziert und damit manuelle Dokumentationsfehler nachhaltig aufgedeckt werden. N2 - Introduction: Since technology is advancing and storage capacities are growing, it is possible to process larger amounts of data. Meanwhile, there is the desire to generate useful knowledge from this aggregated data, which is not found explicitly or cannot be identified at once in the data. PaDaWaN is a parameterizable data warehouse framework for an efficient query and evaluation of homogeneous as well as heterogeneous data sets, which was developed at the University of Würzburg in 2011. Methods: To validate the data warehouse in visceral surgery, automatically generated data from PaDaWaN was compared with manually collected registry data from the EuraHS registry. Patients with a diagnosis of incisional or primary ventral hernia (n=510) were included. For this purpose, information on diagnoses, operations and the materials used intraoperatively were extracted from structured and unstructured data sources of the CIS. Concordance between the information obtained from the different data sources (regarding the exactly same patients) was calculated using the kappa coefficient (IBM SPSS Statistics 24). Results: Applying these methods, discrepancies between ICD-10 codes and medical reports were found. Relying on ICD-10 codes resulted in a marked underestimation of incisional umbilical hernias due to inconsistencies in the ICD 10 classification for primary ventral and incisional hernias. Very good concordance was achieved in the categories mesh implantation in IPOM technique, underlay and sublay position. Factors that influenced the concordance of the data sets were: Recording of prediagnoses, preoperations, inability to recognize negations, and the use of multiple meshes in the same procedure. Classifications such as the “Dietz classification” could be automatically recognized and separated into their components. Conclusion: By establishing Data Warehousing as a clinical research platform, data can be structured and generated faster in the future. The dynamic daily automated data update enables clinical staff to validate and evaluate treatment concepts and results more easily. Furthermore, recommendations for future medical reports can be given in order to improve information extraction of Data Warehousing. The results also show that depending on the intention of data collection, there is a great discrepancy between data regarding the very same patient. Existing registers and data of the CIS can be verified in the sense of an internal validation and thus manual documentation errors can be detected sustainably. KW - datawarehousing KW - hernia KW - surgery KW - PaDaWaN KW - Registerdaten KW - Hernienchirurgie KW - Data Warehouse KW - ICD-10 Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-246743 ER -